Academic literature on the topic 'Open MP compliance'

BackgroundRetifanlimab (INCMGA00012) is a humanized, hinge-stabilized immunoglobulin G4 kappa (IgG4κ), anti-programmed cell death protein (PD)-1 monoclonal antibody with safety and clinical pharmacology that are characteristic for the class. Evaluation of retifanlimab in solid tumors is under investigation in phase 2 and 3 studies. POD1UM-201 is an open-label, single-arm, multicenter, phase 2 study evaluating the efficacy and safety of retifanlimab in patients with chemotherapy-naïve or chemotherapy-refractory advanced/metastatic Merkel cell carcinoma (MCC). Updated results from the chemotherapy-naïve cohort are reported here.MethodsEligible patients were ≥18 years of age, had metastatic or recurrent unresectable loco-regional MCC, Eastern Cooperative Oncology Group performance status ≤1, measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, and had not received prior systemic treatment for MCC. Retifanlimab 500 mg IV every 4 weeks (Q4W) was administered for up to 2 years. The primary endpoint was overall response rate (ORR) assessed by independent central review per RECIST v1.1. Secondary endpoints included duration of response, disease control rate (DCR; defined as proportion of patients with either an objective response or stable disease lasting at least 6 months), progression-free survival, overall survival, safety, and pharmacokinetics.ResultsAs of April 16, 2021, 87 patients with chemotherapy-naïve advanced/metastatic MCC had received retifanlimab. Per protocol, the primary efficacy analyses are based on the first 65 patients assessed. At the data cutoff, 34 of these 65 patients (52.3%) were on treatment; 4 (6.2%) had completed treatment; and 27 (41.5%) had discontinued treatment for reasons including disease progression (18 [27.7%]), adverse event (AE; 7 [10.8%]), death (1 [1.5%]), and physician decision (1 [1.5%]). The ORR in these patients was 46.2% (n=30: complete response, 8 [12.3%]; partial response, 22 [33.8%]). The DCR was 53.8% (n=35). Other secondary efficacy results are not yet mature. Among all treated patients (n=87), 66 (75.9%) had a treatment-emergent AE (TEAE), 25 (28.7%) had a grade ≥3 TEAE, and 12 (13.8%) had a grade ≥3 treatment-related AE. Twenty-three patients (26.4%) had an immune-related AE (irAE), and 8 (9.2%) had a grade ≥3 irAE. Four patients (4.6%) discontinued treatment due to irAEs (peripheral sensorimotor neuropathy, pancreatitis, eosinophilic fasciitis, and polyarthritis [each n=1]). One patient (1.1%) had a grade 3 infusion reaction.ConclusionsThese data from the POD1UM-201 trial show that retifanlimab monotherapy at 500 mg Q4W continues to demonstrate promising clinical activity and safety in patients with advanced/metastatic chemotherapy-naïve MCC. Updated results will be presented at the meeting.AcknowledgementsThe study is sponsored by Incyte Corporation (Wilmington, DE). Statistical support was provided by Xiaohan Xu of Incyte Corporation. Editorial assistance was provided by Matthew Bidgood of Envision Pharma Group (Philadelphia, PA, USA).Trial RegistrationClinicaltrials.gov NCT03599713; EudraCT 2018-001627-39Ethics ApprovalThe study was approved by institutional review boards or independent ethics committees in Canada (McGill University Health Center-Research Ethics Board [MP-37-2019-5103, MEO-37-2019-1616]; Ontario Cancer Research Ethics Board [1728]; Health Research Ethics Board of Alberta – Cancer Committee [HREBA.CC-19-0004, HREBA.CC-19-0020]); Czech Republic (Eticka komise Fakultni nemocnice Kralovske Vinohrady, Eticka komise IKEM a FTNsP, Eticka komise Nemocnice Na Bulovce, Statni ustav pro kontrolu leciv, Eticka komise FN a LF UP Olomouc [169/18MEK24, LEK/04/07/2018, (L-18-85) 8522/23.3.2021, 22.3.2021/9965/EK-Z]); France (Comité de Protection des Personnes Ile de France X [CNRIPH : 18.11.19.49212/Id. 2043]; Agence Nationale de Sécurité du Médicament et des Produits de Santé); Germany (Ethik-Kommission der Medizinischen Fakultaet der Universitaet Duisburg-Essen [18-8371-AF]; Bundesamt fuer Strahlenschutz; Paul-Ehrlich Institute); Hungary (Egeszsegugyi Tudomanyos Tanacs Klinikai Farmakologiai Etikai Bizottsaga [IV/2407-0/2021-EKL, OGYÉI/11697-2/2021]; Orszagos Gyogyszereszeti es Elelmezes-egeszsegugyi Intezet); Italy (Comitato Etico IRCCS Pascale Napoli [116/21 E - 87/18]; Comitato Etico IRCCS di Candiolo [232/2021]; Istituto Tumori Giovanni Paolo II IRCCS Ospedale Oncologico Bari [736/CE]; Comitato Etico Locale per la Sperim. Clin. dei Medicinali dell’Az. Osp.ra Univ.ria Senese di Siena [14107]; Comitato Etico dell’IRCCS Istituto Nazionale per la Ricerca sul Cancro di Genova [389/2018 - 24/05/2021]; Comitato etico degli IRCCS Istituto Europeo di Oncologia e Centro Cardiologico Monzino [IEO 948 - RE3065/IB Edition 7 dated 10Nov2020 (SA7)]; Comitato Etico, Fondazione IRCCS Istituto Nazionale dei Tumori, .c. Medicina Oncologica 1 – Fondazio [INT 01/19]; Comitato Etico IRCCS Istituto Oncologico Veneto di Padova [EM 109/2021]; Comitato Etico dell’IRCCS Istituto Dermopatico dell’Immacolata Ospedale Generale S. Carlo di Roma [550/7]; AIFA – Agenzia Italiana del Farmaco [0040152-01/04/2021-AIFA-AIFA_USC-P]; Comitatao Etico Policlinico di Modena [1017/2018/FARM/AOUMO - EMENDAMENTO SOSTANZIALE IB EDIZIONE 7 DEL 10/11/20 (201800162739-010) (p. 9869/21)]); Poland (Komisja Bioetyczna przy Centrum Onkologii [no. 55/2019]; Office for Registration of Medicinal Products, Medical Devices and Biocidal Products [UR/DBL/D/328/2019]); Spain (CEIC Hospital General Universitario Gregorio Marañon [280/18]; Agencia Española del Medicamento y Productos Sanitarios); Switzerland (Kantonale Ethikkommission Zürich (KEK-Zürich) [2019-00200]; Swissmedic [2019DR2035]); United Kingdom (North East – York Research Ethics Committee [248465]; Medicines and Healthcare products Regulatory Agency; Health Research Authority); United States (Copernicus Group IRB; Western Institutional Review Board [20181738, Work order number -– IQV1-18-309]; Roswell Park Cancer Institute IRB [STUDY00000802/P 75918]; Inova Institutional Review Board, Human Research Protection Program; Stanford IRB Research Compliance Office [48198]; Rush University Medical Center [18072304-IRB01]; University of Miami IRB; Mayo Clinic IRB – Rochester).

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. Available at: https://covid19.who.int/ [Accessed on 23 August 2020] Sim K, Chua HC. The psychological impact of SARS: a matter of heart and mind. CMAJ. 2004; 170:811e2. https://doi.org/10.1503/cmaj.1032003. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatr. 2009; 54:302e11. https://doi.org/10.1177/070674370905400504. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395:912e20. https://doi.org/10.1016/S0140-6736(20)30460-8. Robertson E, Hershenfield K, Grace SL, Stewart DE. The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. Can J Psychiatr. 2004; 49:403e7. https://doi.org/10.1177/070674370404900612. Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep. 2015; 9:547e53. https://doi.org/10.1017/dmp.2015.38. Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016;38: e2016048. https://doi.org/10.4178/epih.e2016048. Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatr. 2012; 53:15e23. https://doi.org/10.1016/j.comppsych.2011.02.003 Chadda RK, Deb KS. Indian family systems, collectivistic society and psychotherapy. Indian J Psychiatry. 2013;55: S299‑ https://dx.doi.org/10.4103%2F0019-5545.105555. Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, et al. Psychological impact of COVID‑19 lockdown: An online survey from India. Indian J Psychiatry. 2020; 62:354-62. https://doi.org/ 10.4103/psychiatry.IndianJPsychiatry _427_20. Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 2010; 40: 218–27. https://dx.doi.org/10.1007%2Fs12160-010-9210-8. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-6736(20)30211-7. Bhandari S, Sharma R, Singh Shaktawat A, Banerjee S, Patel B, Tak A, et al. COVID-19 related mortality profile at a tertiary care centre: a descriptive study. Scr Med. 2020;51(2):69-73. https://doi.org/10.5937/scriptamed51-27126. Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995; 117: 497–529. https://doi.org/10.1037/0033-2909.117.3.497. Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R. Socially isolated children 20 years later: risk of cardiovascular disease. Arch Pediatr Adolesc Med. 2006; 160(8):805-11. https://doi.org/10.1001/archpedi.160.8.805. Eaker ED, Pinsky J, Castelli WP. Myocardial infarction and coronary death among women: psychosocial predictors from a 20-year follow-up of women in the Framingham Study. Am J Epidemiol. 1992; 135(8):854-64. https://doi.org/10.1093/oxfordjournals.aje.a116381. Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med. 2012 Mar; 74(6):907-14. https://dx.doi.org/10.1016%2Fj.socscimed.2011.11.028. Olsen RB, Olsen J, Gunner-Svensson F, Waldstrøm B. Social networks and longevity. A 14-year follow-up study among elderly in Denmark. Soc Sci Med. 1991; 33(10):1189-95. https://doi.org/10.1016/0277-9536(91)90235-5. Patterson AC, Veenstra G. Loneliness and risk of mortality: a longitudinal investigation in Alameda County, California. Soc Sci Med. 2010; 71(1):181-6. https://doi.org/10.1016/j.socscimed.2010.03.024. Savikko N, Routassalo P, Tilvis RS, Strandberg TE, Pitkalla KH. Predictors and subjective causes of loneliness in an aged population. Arch Gerontol Geriatrics. 2005; 41:3;223-33. https://doi.org/10.1016/j.archger.2005.03.002. Health Advisory for Elderly Population of India during COVID19. Available at: https://www.mohfw.gov.in/pdf/AdvisoryforElderlyPopulation.pdf [Accessed on 13 August 2020]. Dicks D, Myers R, Kling A. Uncus and amygdala lesions: effects on social behavior in the free-ranging rhesus monkey. Science. 1969; 165:69–71. https://doi.org/10.1126/science.165.3888.69. Kanai R, Bahrami B, Duchaine B, Janik A, Banissy MJ, Rees G. Brain structure links loneliness to social perception. Curr Biol. 2012; 22(20):1975-9. https://dx.doi.org/10.1016%2Fj.cub.2012.08.045. Bender AR, Daugherty A, Raz N. Vascular risk moderates associations between hippocampal subfield volumes and memory. J Cogn Neurosci. 2013; 25:1851–62. https://doi.org/10.1162/jocn_a_00435. Raz N. Diabetes: brain, mind, insulin–what is normal and do we need to know? Nat Rev Endocrinol. 2011; 7:636–7. https://doi.org/10.1038/nrendo.2011.149. Colcombe SJ, Erickson KI, Naftali R, Andrew GW, Cohen NJ, McAuley E, et al. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Sci. 2003; 58:176–80. https://doi.org/10.1093/gerona/58.2.m176. Maass A, Düzel S, Goerke M, Becke A, Sobieray U, Neumann K, et al. Vascular hippocampal plasticity after aerobic exercise in older adults. Mol Psychiatry. 2015; 20, 585–93. https://doi.org/10.1038/mp.2014.114. Wilson RS, Krueger KR, Arnold SE, Schneider JA, Kelly JF, Barnes LL, et al. Loneliness and Risk of Alzheimer Disease. Arch Gen Psychiatry. 2007;64(2):234–240. https://doi.org/10.1001/archpsyc.64.2.234. Kogan JH, Frankland PW, Silva AJ. Long-term memory underlying hippocampus-dependent social recognition in mice. Hippocampus. 2000;10(1):47-56. https://doi.org/10.1002/(sici)1098-1063(2000)10:1%3C47::aid-hipo5%3E3.0.co;2-6. Yorgason JT, España RA, Konstantopoulos JK, Weiner JL, Jones SR. Enduring increases in anxiety-like behavior and rapid nucleus accumbens dopamine signaling in socially isolated rats. Eur J Neurosci. 2013;37(6):1022-31. https://doi.org/10.1111/ejn.12113. Bledsoe AC, Oliver KM, Scholl JL, Forster GL. Anxiety states induced by post-weaning social isolation are mediated by CRF receptors in the dorsal raphe nucleus. Brain Res Bull. 2011;85(3-4):117-22. https://dx.doi.org/10.1016%2Fj.brainresbull.2011.03.003. Lukkes JL, Engelman GH, Zelin NS, Hale MW, Lowry CA. Post-weaning social isolation of female rats, anxiety-related behavior, and serotonergic systems. Brain Res. 2012; 1443:1-17. https://dx.doi.org/10.1016%2Fj.brainres.2012.01.005. Ago Y, Araki R, Tanaka T, Sasaga A, Nishiyama S, Takuma K, et al. Role of social encounter-induced activation of prefrontal serotonergic systems in the abnormal behaviors of isolation-reared mice. Neuropsychopharmacology. 2013; 38(8):1535-47. https://doi.org/10.1038/npp.2013.52. Veenema AH. Early life stress, the development of aggression and neuroendocrine and neurobiological correlates: what can we learn from animal models? Front Neuroendocrinol. 2009;30(4):497-518. https://doi.org/10.1016/j.yfrne.2009.03.003. Zhao X, Sun L, Jia H, Meng Q, Wu S, Li N, et al. Isolation rearing induces social and emotional function abnormalities and alters glutamate and neurodevelopment-related gene expression in rats. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(7):1173-1177. https://doi.org/10.1016/j.pnpbp.2009.06.016. Sciolino NR, Bortolato M, Eisenstein SA, Fu J, Oveisi F, Hohmann AG, et al. Social isolation and chronic handling alter endocannabinoid signaling and behavioral reactivity to context in adult rats. Neuroscience. 2010;168(2):371-86. https://dx.doi.org/10.1016%2Fj.neuroscience.2010.04.007. Ghasemi M, Phillips C, Trillo L, De Miguel Z, Das D, Salehi A. The role of NMDA receptors in the pathophysiology and treatment of mood disorders. Neurosci Biobehav Rev. 2014; 47:336-358. https://doi.org/10.1016/j.neubiorev.2014.08.017. Olivenza R, Moro MA, Lizasoain I, Lorenzo P, Fernández AP, Rodrigo J, et al. Chronic stress induces the expression of inducible nitric oxide synthase in rat brain cortex. J Neurochem. 2000;74(2):785-791. https://doi.org/10.1046/j.1471-4159.2000.740785.x. Maeng S, Zarate CA Jr, Du J, Schloesser RJ, McCammon J, Chen G, et al. Cellular mechanisms underlying the antidepressant effects of ketamine: role of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptors. Biol Psychiatry. 2008;63(4):349-352. https://doi.org/10.1016/j.biopsych.2007.05.028. Kalia LV, Kalia SK, Salter MW. NMDA receptors in clinical neurology: excitatory times ahead. Lancet Neurol. 2008;7(8):742-755. https://dx.doi.org/10.1016%2FS1474-4422(08)70165-0. Waxman EA, Lynch DR. N-methyl-D-aspartate Receptor Subtypes: Multiple Roles in Excitotoxicity and Neurological Disease. The Neuroscientist. 2005; 11(1), 37–49. https://doi.org/10.1177/1073858404269012. Hermes G, Li N, Duman C, Duman R. Post-weaning chronic social isolation produces profound behavioral dysregulation with decreases in prefrontal cortex synaptic-associated protein expression in female rats. Physiol Behav. 2011;104(2):354-9. https://dx.doi.org/10.1016%2Fj.physbeh.2010.12.019. Sestito RS, Trindade LB, de Souza RG, Kerbauy LN, Iyomasa MM, Rosa ML. Effect of isolation rearing on the expression of AMPA glutamate receptors in the hippocampal formation. J Psychopharmacol. 2011;25(12):1720-1729. https://doi.org/10.1177/0269881110385595. Toua C, Brand L, Möller M, Emsley RA, Harvey BH. The effects of sub-chronic clozapine and haloperidol administration on isolation rearing induced changes in frontal cortical N-methyl-D-aspartate and D1 receptor binding in rats. Neuroscience. 2010;165(2):492-499. https://doi.org/10.1016/j.neuroscience.2009.10.039. Alò R, Avolio E, Mele M, Storino F, Canonaco A, Carelli A et al. Excitatory/inhibitory equilibrium of the central amygdala nucleus gates anti-depressive and anxiolytic states in the hamster. Pharmacol Biochem Behav. 2014; 118:79-86. https://doi.org/10.1016/j.pbb.2014.01.007. St JP, Petkov VV. Changes in 5-HT1 receptors in different brain structures of rats with isolation syndrome. General pharmacology. 1990;21(2):223-5. https://doi.org/10.1016/0306-3623(90)90905-2. Miachon S, Rochet T, Mathian B, Barbagli B, Claustrat B. Long-term isolation of Wistar rats alters brain monoamine turnover, blood corticosterone, and ACTH. Brain Res Bull. 1993;32(6):611-614. https://doi.org/10.1016/0361-9230(93)90162-5. Van den Berg CL, Van Ree JM, Spruijt BM, Kitchen I. Effects of juvenile isolation and morphine treatment on social interactions and opioid receptors in adult rats: behavioural and autoradiographic studies. Eur J Neurosci. 1999;11(9):3023-3032. https://doi.org/10.1046/j.1460-9568.1999.00717.x. Vanderschuren LJ, Stein EA, Wiegant VM, Van Ree JM. Social play alters regional brain opioid receptor binding in juvenile rats. Brain Res. 1995;680(1-2):148-156. https://doi.org/10.1016/0006-8993(95)00256-p. Moles A, Kieffer BL, D'Amato FR. Deficit in attachment behavior in mice lacking the mu-opioid receptor gene. Science. 2004;304(5679):1983-1986. https://doi.org/10.1126/science.1095943. Panksepp J, Herman BH, Vilberg T, Bishop P, DeEskinazi FG. Endogenous opioids and social behavior. Neurosci Biobehav Rev. 1980;4(4):473-487. https://doi.org/10.1016/0149-7634(80)90036-6. Gong JP, Onaivi ES, Ishiguro H, Liu Q, Tagliaferro PA, Brusco A, et al. Cannabinoid CB2 receptors: immunohistochemical localization in rat brain. Brain Res. 2006;1071(1):10-23. https://doi.org/10.1016/j.brainres.2005.11.035. Breivogel CS, Sim-Selley LJ. Basic neuroanatomy and neuropharmacology of cannabinoids. Int Rev Psychiatry 2009; 21:2:113-121. https://doi.org/10.1080/09540260902782760. Haj-Mirzaian A, Amini-Khoei H, Haj-Mirzaian A, Amiri S, Ghesmati M, Zahir M, et al. Activation of cannabinoid receptors elicits antidepressant-like effects in a mouse model of social isolation stress. Brain Res Bull. 2017; 130:200-210. https://doi.org/10.1016/j.brainresbull.2017.01.018. Banach M, Piskorska B, Czuczwar SJ, Borowicz KK. Nitric Oxide, Epileptic Seizures, and Action of Antiepileptic Drugs. CNS & Neurological Disorders - Drug Targets 2011;10: 808. https://doi.org/10.2174/187152711798072347. Förstermann U, Sessa WC. Nitric oxide synthases: regulation and function. Eur Heart J. 2012;33(7):829-37, 837a-837d. https://dx.doi.org/10.1093%2Feurheartj%2Fehr304. Hu Y, Wu D, Luo C, Zhu L, Zhang J, Wu H, et al. Hippocampal nitric oxide contributes to sex difference in affective behaviors. PNAS. 2012, 109 (35) 14224-14229. https://doi.org/10.1073/pnas.1207461109. Khan MI, Ostadhadi S, Zolfaghari S, Mehr SE, Hassanzadeh G, Dehpour, A et al. The involvement of NMDA receptor/NO/cGMP pathway in the antidepressant like effects of baclofen in mouse force swimming test. Neuroscience Letters. 2016; 612:52-61. https://doi.org/10.1016/j.neulet.2015.12.006. Matsumoto K, Puia G, Dong E, Pinna G. GABAA receptor neurotransmission dysfunction in a mouse model of social isolation-induced stress: Possible insights into a non-serotonergic mechanism of action of SSRIs in mood and anxiety disorders. Stress. 2007; 10:1:3-12. https://doi.org/10.1080/10253890701200997. Zlatković J, Filipović D. Chronic social isolation induces NF-κB activation and upregulation of iNOS protein expression in rat prefrontal cortex. Neurochem Int. 2013;63(3):172-179. https://doi.org/10.1016/j.neuint.2013.06.002. Haj-Mirzaian A, Amiri S, Kordjazy N, Momeny M, Razmi A, Balaei MR, et al. Lithium attenuated the depressant and anxiogenic effect of juvenile social stress through mitigating the negative impact of interlukin-1β and nitric oxide on hypothalamic-pituitary-adrenal axis function. Neuroscience. 2016; 315:271-285. https://doi.org/10.1016/j.neuroscience.2015.12.024. Larson HJ. The biggest pandemic risk? Viral misinformation. Nature 2018; 562:309. https://doi.org/10.1038/d41586-018-07034-4. Zarocostas J. How to fight an infodemic. Lancet 2020; 395:676. https://doi.org/10.1016/S0140-6736(20)30461-X. World Health Organization, 2019. Ebola Virus Disease – Democratic Republic of the Congo. Geneva, Switzerland: WHO. Available at: https://www.who.int/csr/don/28-november-2019-ebola-drc/en/ [Accessed on August 8, 2020] Times of India. Covid-19: doctors gone to collect samples attacked in Indore. Available at: https://timesofindia.indiatimes.com/videos/news/covid-19-doctors-goneto- collect-samples-attacked-in-indore/videoshow/74942153.cms; 2020 [Accessed on August 8, 2020]. Withnall A. Coronavirus: why India has had to pass new law against attacks on healthcare workers. The Independent. April 23, 2020. Semple K. “Afraid to be a nurse”: health workers under attack. The New York Times. 2020 Apr 27. The Economist. Health workers become unexpected targets during COVID-19. The Economist. May 11, 2020. Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS Behav. 2017; 21: 283–291. https://doi.org/10.1007/s10461-016-1451-5. James PB, Wardle J, Steel A, Adams J. An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross sectional study. BMC Public Health. 2020; 20: 182. https://doi.org/10.1186/s12889-020-8279-7. Aljazeera, 2020. Iran: Over 700 Dead after Drinking Alcohol to Cure Coronavirus. Aljazeera. Available at: https://www.aljazeera.com/ news/2020/04/iran-700-dead-drinking-alcohol-cure-coronavirus200427163529629.html. (Accessed June 4, 2020) Delirrad M, Mohammadi AB, 2020. New methanol poisoning outbreaks in Iran following COVID-19 pandemic. Alcohol Alcohol. 55: 347–348. https://doi.org/10.1093/alcalc/agaa036. Hassanian-Moghaddam H, Zamani N, Kolahi A-A, McDonald R, Hovda KE. Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran-a cross-sectional assessment. Crit Care. 2020; 24: 402. https://doi.org/10.1186/s13054-020-03140-w. Soltaninejad K. Methanol Mass Poisoning Outbreak: A Consequence of COVID-19 Pandemic and Misleading Messages on Social Media. Int J Occup Environ Med. 2020;11(3):148-150. https://dx.doi.org/10.34172%2Fijoem.2020.1983. Islam MS, Sarkar T, Khan SH, Kamal AM, Hasan SMM, Kabir A, et al. COVID-19–Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis. Am J Trop Med Hyg. 2020; 00(0):1–9. https://doi.org/10.4269/ajtmh.20-0812. Hawryluck L, Gold W, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10(7):1206–1212. https://dx.doi.org/10.3201%2Feid1007.030703. Lee S, Chan LYY, Chau AAM, Kwok KPS, Kleinman A. The experience of SARS-related stigma at Amoy Gardens. Soc Sci Med. 2005; 61(9): 2038-2046. https://doi.org/10.1016/j.socscimed.2005.04.010. Yoon MK Kim SY Ko HS Lee MS. System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. Int J Ment Health Syst. 2016; 10: 51. https://doi.org/10.1186/s13033-016-0083-5. Reynolds DL, Garay JR, Deamond SL, Moran MK, Gold W, Styra R. Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiol Infect. 2008; 136: 997-1007. https://dx.doi.org/10.1017%2FS0950268807009156. Marjanovic Z, Greenglass ER, Coffey S. The relevance of psychosocial variables and working conditions in predicting nurses' coping strategies during the SARS crisis: an online questionnaire survey. Int J Nurs Stud. 2007; 44(6): 991-998. https://doi.org/10.1016/j.ijnurstu.2006.02.012. Bai Y, Lin C-C, Lin C-Y, Chen J-Y, Chue C-M, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004; 55: 1055-1057. https://doi.org/10.1176/appi.ps.55.9.1055. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.pdf [Accessed on 25 August 2020]. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforHomeIsolationofverymildpresymptomaticCOVID19cases10May2020.pdf [Accessed on 25 August 2020]. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/AdvisoryformanagingHealthcareworkersworkinginCOVIDandNonCOVIDareasofthehospital.pdf (Accessed on 25 August 2020). Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforInternationalArrivals02082020.pdf [Accessed on 25 August 2020]. Cost of the lockdown? Over 10% of GDP loss for 18 states. Available at: https://timesofindia.indiatimes.com/india/cost-of-the-lockdown-over-10-of-gdp-loss-for-18-states/articleshow/76028826.cms [Accessed on 21 August 2020]. Jorda O, Singh SR, Taylor AM. Longer-Run Economic Consequences of Pandemics. Federal Reserve Bank of San Francisco Working Paper. 2020-09. https://doi.org/10.24148/wp2020-09. Firdaus G. Mental well‑being of migrants in urban center of India: Analyzing the role of social environment. Indian J Psychiatry. 2017; 59:164‑ https://doi.org/10.4103/psychiatry.indianjpsychiatry_272_15. National Crime Record Bureau. Annual Crime in India Report. New Delhi, India: Ministry of Home Affairs; 2018. 198 migrant workers killed in road accidents during lockdown: Report. Available at: https://www.hindustantimes.com/india-news/198-migrant-workers-killed-in-road-accidents-during-lockdown-report/story-hTWzAWMYn0kyycKw1dyKqL.html [Accessed on 25 August 2020]. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020; 20:689-96. https://doi.org/10.1016/S1473-3099(20)30198-5. Dalton L, Rapa E, Stein A. Protecting the psychological health of through effective communication about COVID-19. Lancet Child Adolesc Health. 2020;4(5):346-347. https://doi.org/10.1016/S2352-4642(20)30097-3. Centre for Disease Control. Helping Children Cope with Emergencies. Available at: https://www.cdc.gov/childrenindisasters/helping-children-cope.html [Accessed on 25 August 2020]. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child & Adolesc Health. 2020; 4(5):347-349. https://doi.org/10.1016/S2352-4642(20)30096-1. Sprang G, Silman M. Posttraumatic Stress Disorder in Parents and Youth After Health-Related Disasters. Disaster Med Public Health Prep. 2013;7(1):105-110. https://doi.org/10.1017/dmp.2013.22. Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. Depression, Anxiety and Stress Among Indians in Times of Covid-19 Lockdown. Community Ment Health J. 2020:1-7. https://doi.org/10.1007/s10597-020-00664-x. Cao W, Fang Z, Hou, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research. 2020; 287:112934. https://doi.org/10.1016/j.psychres.2020.112934. Wang C, Zhao H. The Impact of COVID-19 on Anxiety in Chinese University Students. Front Psychol. 2020; 11:1168. https://dx.doi.org/10.3389%2Ffpsyg.2020.01168. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7(3): e14. https://doi.org/10.1016/s2215-0366(20)30047-x. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3(3): e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976. Lancee WJ, Maunder RG, Goldbloom DS, Coauthors for the Impact of SARS Study. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv. 2008;59(1):91-95. https://dx.doi.org/10.1176%2Fps.2008.59.1.91. Tam CWC, Pang EPF, Lam LCW, Chiu HFK. Severe acute respiratory syndrome (SARS) in Hongkong in 2003: Stress and psychological impact among frontline healthcare workers. Psychol Med. 2004;34 (7):1197-1204. https://doi.org/10.1017/s0033291704002247. Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018; 87:123-127. https://dx.doi.org/10.1016%2Fj.comppsych.2018.10.003. Koh D, Meng KL, Chia SE, Ko SM, Qian F, Ng V, et al. Risk perception and impact of severe acute respiratory syndrome (SARS) on work and personal lives of healthcare workers in Singapore: What can we learn? Med Care. 2005;43(7):676-682. https://doi.org/10.1097/01.mlr.0000167181.36730.cc. Verma S, Mythily S, Chan YH, Deslypere JP, Teo EK, Chong SA. Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore. Ann Acad Med Singap. 2004; 33(6):743e8. Yeung J, Gupta S. Doctors evicted from their homes in India as fear spreads amid coronavirus lockdown. CNN World. 2020. Available at: https://edition.cnn.com/2020/03/25/asia/india-coronavirus-doctors-discrimination-intl-hnk/index.html. [Accessed on 24 August 2020] Violence Against Women and Girls: the Shadow Pandemic. UN Women. 2020. May 3, 2020. Available at: https://www.unwomen.org/en/news/stories/2020/4/statement-ed-phumzile-violence-against-women-during-pandemic. [Accessed on 24 August 2020]. Gearhart S, Patron MP, Hammond TA, Goldberg DW, Klein A, Horney JA. The impact of natural disasters on domestic violence: an analysis of reports of simple assault in Florida (1999–2007). Violence Gend. 2018;5(2):87–92. https://doi.org/10.1089/vio.2017.0077. Sahoo S, Rani S, Parveen S, Pal Singh A, Mehra A, Chakrabarti S, et al. Self-harm and COVID-19 pandemic: An emerging concern – A report of 2 cases from India. Asian J Psychiatr 2020; 51:102104. https://dx.doi.org/10.1016%2Fj.ajp.2020.102104. Ghosh A, Khitiz MT, Pandiyan S, Roub F, Grover S. Multiple suicide attempts in an individual with opioid dependence: Unintended harm of lockdown during the COVID-19 outbreak? Indian J Psychiatry 2020; [In Press]. The Economic Times. 11 Coronavirus suspects flee from a hospital in Maharashtra. March 16 2020. Available at: https://economictimes.indiatimes.com/news/politics-and-nation/11-coronavirus-suspects-flee-from-a-hospital-in-maharashtra/videoshow/74644936.cms?from=mdr. [Accessed on 23 August 2020]. Xiang Y, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry 2020;(3):228–229. https://doi.org/10.1016/S2215-0366(20)30046-8. Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma A, Muana A, et al. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull World Health Organ. 2016;94(3):210–214. https://dx.doi.org/10.2471%2FBLT.15.158543. Kumar A, Nayar KR. COVID 19 and its mental health consequences. Journal of Mental Health. 2020; ahead of print:1-2. https://doi.org/10.1080/09638237.2020.1757052. Gupta R, Grover S, Basu A, Krishnan V, Tripathi A, Subramanyam A, et al. Changes in sleep pattern and sleep quality during COVID-19 lockdown. Indian J Psychiatry. 2020; 62(4):370-8. https://doi.org/10.4103/psychiatry.indianjpsychiatry_523_20. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4): P300-302. https://doi.org/10.1016/S2215-0366(20)30073-0. Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020; 14(5): 779–788. https://dx.doi.org/10.1016%2Fj.dsx.2020.05.035. Wright R. The world's largest coronavirus lockdown is having a dramatic impact on pollution in India. CNN World; 2020. Available at: https://edition.cnn.com/2020/03/31/asia/coronavirus-lockdown-impact-pollution-india-intl-hnk/index.html. [Accessed on 23 August 2020] Foster O. ‘Lockdown made me Realise What’s Important’: Meet the Families Reconnecting Remotely. The Guardian; 2020. Available at: https://www.theguardian.com/keep-connected/2020/apr/23/lockdown-made-me-realise-whats-important-meet-the-families-reconnecting-remotely. (Accessed on 23 August 2020) Bilefsky D, Yeginsu C. Of ‘Covidivorces’ and ‘Coronababies’: Life During a Lockdown. N. Y. Times; 2020. Available at: https://www.nytimes.com/2020/03/27/world/coronavirus-lockdown-relationships.html [Accessed on 23 August 2020]

In recent years, soft robots gain increasing attention as a result of their compliance when operating in unstructured environments, and their flexibility that ensures safety when interacting with humans. However, challenges lie on the difficulty to develop control algorithms due to various limitations induced by their soft structure. In this paper, we introduce a novel technique that aims to perform motion control of a modular bio-inspired soft-robotic arm, with the main focus lying on facilitating the qualitative reproduction of well-specified periodic trajectories. The introduced method combines the notion behind two previously developed methodologies both based on the Movement Primitive (MP) theory, by exploiting their capabilities while coping with their main drawbacks. Concretely, the requested actuation is initially computed using a Probabilistic MP (ProMP)-based method that considers the trajectory as a combination of simple movements previously learned and stored as a MP library. Subsequently, the key components of the resulting actuation are extracted and filtered in the frequency domain. These are eventually used as input to a Central Pattern Generator (CPG)-based model that takes over the generation of rhythmic patterns at the motor level. The proposed methodology is evaluated on a two-module soft arm. Results show that the first algorithmic component (ProMP) provides an immediate estimation of the requested actuation by avoiding time-consuming training, while the latter (CPG) further simplifies the execution by allowing its control through a low-dimensional parameterization. Altogether, these results open new avenues for the rapid acquisition of periodic movements in soft robots, and their compression into CPG parameters for long-term storage and execution.

ObjectiveTo develop, evaluate, and implement a universal online platform - termed OPEN Stewardship - to promote responsible antimicrobial prescribing (antimicrobial stewardship).IntroductionAntibiotic resistance is a mounting public health threat calling for action on global, national and local levels. Antibiotic use has been a major driver of increasing rates of antibiotic resistance. This has given rise to the practice of antibiotic stewardship, which seeks to reduce unnecessary antibiotic use across different care settings. Antibiotic stewardship has been increasingly applied in hospital settings, but adoption has been slow in many ambulatory care settings including primary care of humans. Uptake of antibiotic stewardship in veterinary care has been similarly limited. Audit and feedback systems of antibiotic use coupled with patterns of antibiotic use and best practice guidelines have proven useful in outpatient settings, but scale-up is limited by heterogeneous systems of care and limited resources.MethodsA multi-sectoral team with partners from Canada, Israel and Sweden is developing a web-based platform for administering antibiotic stewardship across multiple care settings and sectors, for human and animal prescribers. There are several interventions which support behaviour change and can be applied to antibiotic stewardship programs. Systematic reviews have found beneficial effects of numerous behaviour change interventions for optimizing clinical practice such as computerized reminders [1], opinion leaders as champions for change [2], and audit and feedback [3]. A recent Cochrane review [4] found that interventions to enable correct use of antibiotics improved policy compliance, and that enabling interventions that included feedback were more likely to be effective. We will use antibiotic prescribing benchmarking, focused guidelines, and local patterns of antibiotic resistance as key components that can be deployed as feedback through this antibiotic stewardship platform.The OPEN Stewardship platform will be hosted on an AWS cloud-based server using industry standard encryption. The platform will function with a central administrator who will enroll and deliver feedback to participating prescribers. This platform will be evaluated prospectively in two countries (Canada and Israel) to evaluate user experience of the feedback as well as impact on antimicrobial prescribing. The evaluation will include prescribers from both human and animal health. After the prospective evaluation, the platform will be made available online for broad multi-sectoral use.ResultsWe have designed the interface for a web-based platform for antibiotic stewardship which will be used in a multinational prospective primary care stewardship intervention in 2019 and 2020 and subsequently rolled out for broad public use (www.openasp.org). The platform layout can be seen in Figure 1. Data capture for aggregate prescriber level antibiotic use and local guidelines will be possible through both a manual graphical user interface and a dataset template upload. Antibiotic resistance data will be pulled from a companion database (www.resistanceopen.org). Administrators will be able to generate unique feedback forms containing visualizations and snapshots from antibiotic use, guidelines, and antibiotic resistance data (Figure 2). These can then be delivered by email on an individual or scheduled basis for one or multiple prescribers simultaneously. Participating prescribers will also have the option to login to view their own profile and browse antibiotic use, resistance and guidelines.ConclusionsAntibiotic stewardship needs to be adopted in a fashion that is country and context specific and not administered from the top down. With our approach we seek to empower groups from any country or care setting to provide regional and tailored stewardship feedback through an open interface. We have here demonstrated the design of an web-based antibiotic stewardship platform which will be evaluated prospectively and subsequently made available for open and broad multi-sectoral use - in keeping with a One Health approach.References1. Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD001096.2. Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009255.3. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259.4. Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD003543.

IntroductionIn Britain, hunger is often hidden in the privacy of the home. Yet otherwise private hunger is currently being rendered public and visible in the growing queues at charity-run food banks, where emergency food parcels are distributed directly to those who cannot afford to feed themselves or their families adequately (Downing et al.; Caplan). Food banks, in providing emergency relief to those in need, are responses to crisis moments, actualised through an embodied feeling of hunger that cannot be alleviated. The growing queues at food banks not only render hidden hunger visible, but also serve as reminders of the corporeal vulnerability of the human body to political and socio-economic shifts.A consideration of corporeality allows us to view the world through the lived experiences of the body. Human beings are “creatures of the flesh” who understand and reason, act and interact with their environments through the body (Johnson 81). The growing academic interest in corporeality signifies what Judith Butler calls a “new bodily ontology” (2). However, as Butler highlights, the body is also vulnerable to injury and suffering. An application of this ontology to hunger draws attention to eating as essential to life, so the denial of food poses an existential threat to health and ultimately to survival. The body’s response to threat is the physiological experience of hunger as a craving or longing that is the “most bodily experience of need […] a visceral desire locatable in a void” in which an empty stomach “initiates” a series of sounds and pangs that “call for action” in the form of eating (Anderson 27). Food bank queues serve as visible public reminders of this precariousness and of how social conditions can limit the ability of individuals to feed themselves, and so respond to an existential threat.Corporeal vulnerability made visible elicits responses that support societal interventions to feed the hungry, or that stigmatise hungry people by withdrawing or disparaging what limited support is available. Responses to vulnerability therefore evoke nurture and care or violence and abuse, and so in this sense are ambiguous (Butler; Cavarero). The responses are also normative, shaped by social and cultural understandings of what hunger is, what its causes are, and whether it is seen as originating in personal or societal failings. The stigmatising of individuals by blaming them for their hunger is closely allied to the feelings of shame that lie at the “irreducible absolutist core” of the idea of poverty (Sen 159). Shame is where the “internally felt inadequacies” of the impoverished individual and the “externally inflicted judgments” of society about the hungry body come together in a “co-construction of shame” (Walker et al. 5) that is a key part of the lived experience of hunger. The experience of shame, while common, is far from inevitable and is open to resistance (see Pickett; Foucault); shame can be subverted, turned from the hungry body and onto the society that allows hunger to happen. Who and what are deemed responsible are shaped by shifting ideas and contested understandings of hunger at a particular moment in time (Vernon).This exploration of corporeal vulnerability through food banks as a historically located response to hunger offers an alternative to studies which privilege representations, objectifying the body and “treating it as a discursive, textual, iconographic and metaphorical reality” while neglecting understandings derived from lived experiences and the responses that visible vulnerabilities elicit (Hamilakis 99). The argument made in this paper calls for a critical reconsideration of classic political economy approaches that view hunger in terms of a class struggle against the material conditions that give rise to it, and responses that ultimately led to the construction of the welfare state (Vernon). These political economy approaches, in focusing on the structures that lead to hunger and that respond to it, are more closed than Butler’s notion of ambiguous and constantly changing social responses to corporeal vulnerability. This paper also challenges the dominant tradition of nutrition science, which medicalises hunger. While nutrition science usefully draws attention to the physiological experiences and existential threat posed by acute hunger, the scientific focus on the “anatomical functioning” of the body and the optimising of survival problematically separates eating from the social contexts in which hunger is experienced (Lupton 11, 12; Abbots and Lavis). The focus in this article on the corporeal vulnerability of hunger interweaves contested representations of, and ideas about, hunger with the physiological experience of it, the material conditions that shape it, and the lived experiences of deprivation. Food banks offer a lens onto these experiences and their complexities.Food Banks: Deprivation Made VisibleSince the 1980s, food banks have become the fastest growing charitable organisations in the wealthiest countries of North America, Europe, and Australasia (Riches), but in Britain they are a recent phenomenon. The first opened in 2000, and by 2014, the largest operator, the Trussell Trust, had over 420 franchised food banks, and more recently was opening more than one per week (Lambie-Mumford et al.; Lambie-Mumford and Dowler). British food banks hand out emergency food relief directly to those who cannot afford to feed themselves or their families adequately, and have become new sites where deprivation is materialised through a congregation of hungry people and the distribution of food parcels. The food relief parcels are intended as short-term immediate responses to crisis moments felt within the body when the individual cannot alleviate hunger through their own resources; they are for “emergency use only” to ameliorate individual crisis and acute vulnerability, and are not intended as long-term solutions to sustained, chronic poverty (Perry et al.). The need for food banks has emerged with the continued shrinkage of the welfare state, which for the past half century sought to mediate the impact of changing individual and social circumstances on those deemed to be most vulnerable to the vicissitudes of life. The proliferation of food banks since the 2009 financial crisis and the increased public discourse about them has normalised their presence and naturalised their role in alleviating acute food poverty (Perry et al.).Media images of food bank queues and stacks of tins waiting to be handed out (Glaze; Gore) evoke collective memories from the early twentieth century of hunger marches in protest at government inaction over poverty, long queues at soup kitchens, and the faces of gaunt, unemployed war veterans (Vernon). After the Second World War, the spectre of communism and the expansionist agenda of the Soviet Union meant such images of hunger could become tools in a propaganda war constructed around the failure of the British state to care for its citizens (Field; Clarke et al; Vernon). The 1945 Labour government, elected on a social democratic agenda of reform in an era of food rationing, responded with a “war on want” based on the normative premise that no one should be without food, medical care, shelter, warmth or work. Labour’s response was the construction of the modern welfare state.The welfare state signified a major shift in ideational understandings of hunger. In the seventeenth and eighteenth centuries, ideas about hunger had been rooted in a moralistic account of divine punishment for individual failure (Vernon). Bodily experiences of hunger were seen as instruments for disciplining the indigent into a work ethic appropriate for a modern industrialised economy. The infamous workhouses, finally abolished in 1948, were key sites of deprivation where restrictions on how much food was distributed served to punish or discipline the hungry body into compliance with the dominant work ethic (Vernon; Foucault). However, these ideas shifted in the second half of the nineteenth century as the hungry citizen in Britain (if not in its colonies) was increasingly viewed as a victim of wider forces beyond the control of the individual, and the notion of disciplining the hungry body in workhouses was seen as reprehensible. A humanitarian treatment of hunger replaced a disciplinarian one as a more appropriate response to acute need (Shaw; Vernon). Charitable and reformist organisations proliferated with an agenda to feed, clothe, house, and campaign on behalf of those most deprived, and civil society largely assumed responsibility for those unable to feed themselves. By the early 1900s, ideas about hunger had begun to shift again, and after the Second World War ideational changes were formalised in the welfare state, premised on a view of hunger as due to structural rather than individual failure, hence the need for state intervention encapsulated in the “cradle to grave” mantra of the welfare state, i.e. of consistent care at the point of need for all citizens for their lifetime (see Clarke and Newman; Field; Powell). In this context, the suggestion that Britons could go to bed hungry because they could not afford to feed themselves would be seen as the failure of the “war on want” and of an advanced modern democracy to fulfil its responsibilities for the welfare of its citizens.Since the 1980s, there has been a retreat from these ideas. Successive governments have sought to rein in, reinvent or shrink what they have perceived as a “bloated” welfare state. In their view this has incentivised “dependency” by providing benefits so generous that the supposedly work-shy or “skivers” have no need to seek employment and can fund a diet of takeaways and luxury televisions (Howarth). These stigmatising ideas have, since the 2009 financial crisis and the 2010 election, become more entrenched as the Conservative-led government has sought to renew a neo-liberal agenda to shrink the welfare state, and legitimise a new mantra of austerity. This mantra is premised on the idea that the state can no longer afford the bloated welfare budget, that responsible government needs to “wean” people off benefits, and that sanctions imposed for not seeking work or for incorrectly filling in benefit claim forms serve to “encourage” people into work. Critics counter-argue that the punitive nature of sanctions has exacerbated deprivation and contributed to the growing use of food banks, a view the government disputes (Howarth; Caplan).Food Banks as Sites of Vulnerable CorporealityIn these shifting contexts, food banks have proliferated not only as sites of deprivation but also as sites of vulnerable corporeality, where people unable to draw on individual resources to respond to hunger congregate in search of social and material support. As growing numbers of people in Britain find themselves in this situation, the vulnerable corporeality of the hungry body becomes more pervasive and more visible. Hunger as a lived experience is laid bare in ever-longer food bank queues and also through the physiological, emotional and social consequences graphically described in personal blogs and in the testimonies of food bank users.Blogger Jack Monroe, for example, has recounted giving what little food she had to her child and going to bed hungry with a pot of ginger tea to “ease the stomach pains”; saying to her curious child “I’m not hungry,” while “the rumblings of my stomach call me a liar” (Monroe, Hunger Hurts). She has also written that her recourse to food banks started with the “terrifying and humiliating” admission that “you cannot afford to feed your child” and has expressed her reluctance to solicit the help of the food bank because “it feels like begging” (Monroe, Austerity Works?). Such blog accounts are corroborated in reports by food bank operators and a parliamentary enquiry which told stories of mothers not eating for days after being sanctioned under the benefit system; of children going to school hungry; of people leaving hospital after a major operation unable to feed themselves since their benefits have been cut; of the elderly having to make “hard choices” between “heat or eat” each winter; and of mixed feelings of relief and shame at receiving food bank parcels (All-Party Parliamentary Inquiry; Beattie; Cooper and Dumpleton; Caplan; Perry et al.). That is, two different visibilities have emerged: the shame of standing or being seen to stand in the food bank queue, and blogs that describe these feelings and the lived experience of hunger – both are vulnerable and visible, but in different ways and in different spaces: the physical or material, and the virtual.The response of doctors to the growing evidence of crisis was to warn that there were “all the signs of a public health emergency that could go unrecognised until it is too late to take preventative action,” that progress made against food poverty since the 1960s was being eroded (Ashton et al. 1631), and that the “robust last line of defence against hunger” provided by the welfare state was failing (Loopstra et al. n.p). Medical professionals thus sought to conscript the rhetorical resources of their professional credibility to highlight that this is a politically created public health crisis.This is not to suggest that acute hunger was absent for 50 years of the welfare state, but that with the closure of the last workhouses, the end of hunger marches, and the shutting of the soup kitchens by the 1950s, it became less visible. Over the past decade, hunger has become more visible in images of growing queues at food banks and stacked tins ready to be handed out by volunteers (Glaze; Gore) on production of a voucher provided on referral by professionals. Doctors, social workers or teachers are therefore tasked with discerning cases of need, deciding whose need is “genuine” and so worthy of food relief (see Downing et al.). The voucher system is regulated by professionals so that food banks are open only to those with a public identity constructed around bodily crisis. The sense of something as intimate as hunger being defined by others contrasts to making visible one’s own hunger through blogging. It suggests again how bodies become caught up in wider political struggles where not only is shame a co-construction of internal inadequacies and external judgements, but so too is hunger, albeit in different yet interweaving ways. New boundaries are being established between those who are deprived and those who are not, and also between those whose bodies are in short-term acute crisis, and those whose bodies are in long-term and chronic crisis, which is not deemed to be an emergency. It is in this context that food banks have also become sites of demarcation, shame, and contestation.Public debates about growing food bank queues highlight the ambiguous nature of societal responses to the vulnerability of hunger made visible. Government ministers have intensified internal shame in attributing growing food bank queues to individual inadequacies, failure to manage household budgets (Gove), and profligate spending on luxury (Johnston; Shipton). Civil society organisations have contested this account of hunger, turning shame away from the individual and onto the government. Austerity reforms have, they argue, “torn apart” the “basic safety net” of social responses to corporeal vulnerability put in place after the Second World War and intended to ensure that no-one was left hungry or destitute (Bingham), their vulnerability unattended to. Furthermore, the benefit sanctions impose punitive measures that leave families with “nothing” to live on for weeks. Hungry citizens, confronted with their own corporeal vulnerability and little choice but to seek relief from food banks, echo the Dickensian era of the workhouse (Cooper and Dumpleton) and indict the UK government response to poverty. Church leaders have called on the government to exercise “moral duty” and recognise the “acute moral imperative to act” to alleviate the suffering of the hungry body (Beattie; see also Bingham), and respond ethically to corporeal vulnerability with social policies that address unmet need for food. However, future cuts to welfare benefits mean the need for relief is likely to intensify.ConclusionThe aim of this paper was to explore the vulnerable corporeality of hunger through the lens of food banks, the twenty-first-century manifestations of charitable responses to acute need. Food banks have emerged in a gap between the renewal of a neo-liberal agenda of prudent government spending and the retreat of the welfare state, between struggles over resurgent ideas about individual responsibility and deep disquiet about wider social responsibilities. Food banks as sites of deprivation, in drawing attention to a newly vulnerable corporeality, potentially pose a threat to the moral credibility of the neo-liberal state. The threat is highlighted when the taboo of a hungry body, previously hidden because of shame, is being challenged by two new visibilities, that of food bank queues and the commentaries on blogs about the shame of having to queue for food.ReferencesAbbots, Emma-Jayne, and Anna Lavis. Eds. Why We Eat, How We Eat: Contemporary Encounters between Foods and Bodies. Farnham: Ashgate, 2013.All-Party Parliamentary Inquiry. “Feeding Britain.” 2014. 6 Jan. 2016 <https://foodpovertyinquiry.files.wordpress.com/2014/12/food>.Anderson, Patrick. “So Much Wasted:” Hunger, Performance, and the Morbidity of Resistance. Durham: Duke UP, 2010.Ashton, John R., John Middleton, and Tim Lang. “Open Letter to Prime Minister David Cameron on Food Poverty in the UK.” The Lancet 383.9929 (2014): 1631.Beattie, Jason. “27 Bishops Slam David Cameron’s Welfare Reforms as Creating a National Crisis in Unprecedented Attack.” Mirror 19 Feb. 2014. 6 Jan. 2016 <http://www.mirror.co.uk/news/uk-news/27-bishops-slam-david-camerons-3164033>.Bingham, John. “New Cardinal Vincent Nichols: Welfare Cuts ‘Frankly a Disgrace.’” Telegraph 14 Feb. 2014. 6 Jan. 2016 <http://www.telegraph.co.uk/news/religion/10639015/>.Butler, Judith. Frames of War: When Is Life Grievable? London: Verso, 2009.Cameron, David. “Why the Archbishop of Westminster Is Wrong about Welfare.” The Telegraph 18 Feb. 2014. 6 Jan. 2016 <http://www.telegraph.co.uk/news/politics/david-cameron/106464>.Caplan, Pat. “Big Society or Broken Society?” Anthropology Today 32.1 (2016): 5–9.Cavarero, Adriana. Horrorism: Naming Contemporary Violence. New York: Columbia UP, 2010.Chase, Elaine, and Robert Walker. “The Co-Construction of Shame in the Context of Poverty: Beyond a Threat to the Social Bond.” Sociology 47.4 (2013): 739–754.Clarke, John, Sharon Gewirtz, and Eugene McLaughlin (eds.). New Managerialism, New Welfare. London: Sage, 2000.Clarke, John, and Janet Newman. The Managerial State: Power, Politics and Ideology in the Remaking of Social Welfare. London: Sage, 1997.Cooper, Niall, and Sarah Dumpleton. “Walking the Breadline.” Church Action on Poverty/Oxfam May (2013): 1–20. 6 Jan. 2016 <http://policy-practice.oxfam.org.uk/publications/walking-the-breadline-the-scandal-of-food-poverty-in-21st-century-britain-292978>.Crossley, Nick. “The Politics of the Gaze: Between Foucault and Merleau-Ponty.” Human Studies 16.4 (1996): 399–419.Downing, Emma, Steven Kennedy, and Mike Fell. Food Banks and Food Poverty. London: House of Commons, 2014. 6 Jan. 2016 <http://www.parliament.uk/briefing-papers/SN06657/food-banks-and-food-poverty>.Field, Frank. “The Welfare State – Never Ending Reform.” BBC 3 Oct. 2011. 6 Jan. 2016 <http://www.bbc.co.uk/history/british/modern/field_01.shtml>.Foucault, Michel. Madness and Civilization: A History of Insanity in an Age of Reason. Trans. Richard Howard. New York: Random House, 1996.Glaze, Ben. “Tens of Thousands of Families Will Only Eat This Christmas Thanks to Food Banks.” The Mirror 23 Dec. 2015. 6 Jan. 2016 <http://www.mirror.co.uk/news/uk-news/tens-thousands-families-only-eat-705>.Gore, Alex. “Schools Teach Cookery on Fridays So Hungry Children from Families Too Poor to Eat Have Food for the Weekend.” The Daily Mail 28 Oct. 2012. 6 Jan. 2016. <http://www.dailymail.co.uk/news/article-2224304/Schools-teach-cookery-Friday>.Gove, Michael. “Education: Topical Questions.” Oral Answers to Questions 2 Sep. 2013.Hamilakis, Yannis. “Experience and Corporeality: Introduction.” Thinking through the Body: Archaeologies of Corporeality. Eds. Yannis Hamilakis, Mark Pluciennik, and Sarah Tarlow. New York: Kluwer Academic, 2002. 99-105.Howarth, Anita. “Hunger Hurts: The Politicization of an Austerity Food Blog.” International Journal of E-Politics 6.3 (2015): 13–26.Johnson, Mark. “Human Beings.” The Journal of Philosophy LXXXIV.2 (1987): 59–83.Johnston, Lucy. “Edwina Currie’s Cruel Jibe at the Poor.” Sunday Express Jan. 2014. 6 Jan. 2016 <http://www.express.co.uk/news/uk/454730/Edwina-Currie-s-cruel-jibe-at-poor>.Lambie-Mumford, Hannah, Daniel Crossley, and Eric Jensen. Household Food Security in the UK: A Review of Food Aid Final Report. February 2014. Food Ethics Council and the University of Warwick. 6 Jan. 2016 <https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/283071/household-food-security-uk-140219.pdf>.Lambie-Mumford, Hannah, and Elizabeth Dowler. “Rising Use of ‘Food Aid’ in the United Kingdom.” British Food Journal 116 (2014): 1418–1425.Loopstra, Rachel, Aaron Reeves, David Taylor-Robinson, Ben Barr, Martin McKee, and David Stuckler. “Austerity, Sanctions, and the Rise of Food Banks in the UK.” BMJ 350 (2015).Lupton, Deborah. Food, the Body and the Self. London: Sage, 1996.Monroe, Jack. “Hunger Hurts.” A Girl Called Jack 30 July 2012. 6 Jan. 2016 <http://agirlcalledjack.com/2012/07/30/hunger-hurts/>.———. “Austerity Works? We Need to Keep Making Noise about Why It Doesn’t.” Guardian 10 Sep. 2013. 6 Jan. 2016 <http://www.theguardian.com/commentisfree/2013/sep/10/austerity-poverty-frugality-jack-monroe>.Perry, Jane, Martin Williams, Tom Sefton and Moussa Haddad. “Emergency Use Only: Understanding and Reducing the Use of Food Banks in the UK.” Child Poverty Action Group, The Church of England, Oxfam and The Trussell Trust. Nov. 2014. 6 Jan. 2016 <http://www.cpag.org.uk/sites/default/files/Foodbank Report_web.pdf>.Pickett, Brent. “Foucault and the Politics of Resistance.” Polity 28.4 (1996): 445–466.Powell, Martin. “New Labour and the Third Way in the British Welfare State: A New and Distinctive Approach?” Critical Social Policy 20.1 (2000): 39–60. Riches, Graham. “Food Banks and Food Security: Welfare Reform, Human Rights and Social Policy: Lessons from Canada?” Social Policy and Administration 36.6 (2002): 648–663.Sen, Amartya. “Poor, Relatively Speaking.” Oxford Economic Papers 35.2 (1983): 153–169. Shaw, Caroline. Britannia’s Embrace: Modern Humanitarianism and the Imperial Origins of Refugee Relief. Oxford: Oxford UP, 2015.Shipton, Martin. “Vale of Glamorgan MP Alun Cairns in Food Bank Row after Claims Drug Addicts Use Them.” Wales Online Sep. 2015. 6 Jan. 2016. <http://www.walesonline.co.uk/news/wales-news/vale-glamorgan-tory-mp-alun-6060730>. Vernon, James. Hunger: A Modern History. Cambridge, MA: Harvard UP, 2009.Walker, Robert, Sarah Purcell, and Ruth Jackson “Poverty in Global Perspective: Is Shame a Common Denominator?” Journal of Social Policy 42.02 (2013): 215–233.

In order to explore further the capabilities of parallel computing architectures such as grids, clusters, multi-processors and more recently, clouds and multi-cores, an easy-to-use parallel language is an important challenging issue. From the programmer's point of view, OpenMP is very easy to use with its ability to support incremental parallelization, features for dynamically setting the number of threads and scheduling strategies. However, as initially designed for shared memory systems, OpenMP is usually limited on distributed memory systems to intra-nodes' computations. Many attempts have tried to port OpenMP on distributed systems. The most emerged approaches mainly focus on exploiting the capabilities of a special network architecture and therefore cannot provide an open solution. Others are based on an already available software solution such as DMS, MPI or Global Array and, as a consequence, they meet difficulties to become a fully-compliant and high-performance implementation of OpenMP. As yet another attempt to built an OpenMP compliant implementation for distributed memory systems, CAPE − which stands for Checkpointing Aide Parallel Execution − has been developed which with the following idea: when reaching a parallel section, the master thread is dumped and its image is sent to slaves; then, each slave executes a different thread; at the end of the parallel section, slave threads extract and return to the master thread the list of all modifications that has been locally performed; the master includes these modifications and resumes its execution. In order to prove the feasibility of this paradigm, the first version of CAPE was implemented using complete checkpoints. However, preliminary analysis showed that the large amount of data transferred between threads and the extraction of the list of modifications from complete checkpoints lead to weak performance. Furthermore, this version was restricted to parallel problems satisfying the Bernstein's conditions, i.e. it did not solve the requirements of shared data. This thesis aims at presenting the approaches we proposed to improve CAPE' performance and to overcome the restrictions on shared data. First, we developed DICKPT which stands for Discontinuous Incremental Checkpointing, an incremental checkpointing technique that supports the ability to save incremental checkpoints discontinuously during the execution of a process. Based on the DICKPT, the execution speed of the new version of CAPE was significantly increased. For example, the time to compute a large matrix-matrix product on a desktop cluster has become very similar to the execution time of the same optimized MPI program. Moreover, the speedup associated with this new version for various number of threads is quite linear for different problem sizes. In the side of shared data, we proposed UHLRC, which stands for Updated Home-based Lazy Release Consistency, a modified version of the Home-based Lazy Release Consistency (HLRC) memory model, to make it more appropriate to the characteristics of CAPE. Prototypes and algorithms to implement the synchronization and OpenMP data-sharing clauses and directives are also specified. These two works ensures the ability for CAPE to respect shared-data behavior

Afin d'exploiter les capacités des architectures parallèles telles que les grappes, les grilles, les systèmes multi-processeurs, et plus récemment les nuages et les systèmes multi-cœurs, un langage de programmation universel et facile à utiliser reste à développer. Du point de vue du programmeur, OpenMP est très facile à utiliser en grande partie grâce à sa capacité à supporter une parallélisation incrémentale, la possibilité de définir dynamiquement le nombre de fils d'exécution, et aussi grâce à ses stratégies d'ordonnancement. Cependant, comme il a été initialement conçu pour des systèmes à mémoire partagée, OpenMP est généralement très limité pour effectuer des calculs sur des systèmes à mémoire distribuée. De nombreuses solutions ont été essayées pour faire tourner OpenMP sur des systèmes à mémoire distribuée. Les approches les plus abouties se concentrent sur l’exploitation d’une architecture réseau spéciale et donc ne peuvent fournir une solution ouverte. D'autres sont basées sur une solution logicielle déjà disponible telle que DMS, MPI ou Global Array, et par conséquent rencontrent des difficultés pour fournir une implémentation d'OpenMP complètement conforme et à haute performance. CAPE — pour Checkpointing Aided Parallel Execution — est une solution alternative permettant de développer une implémentation conforme d'OpenMP pour les systèmes à mémoire distribuée. L'idée est la suivante : en arrivant à une section parallèle, l'image du thread maître est sauvegardé et est envoyée aux esclaves ; puis, chaque esclave exécute l'un des threads ; à la fin de la section parallèle, chaque threads esclaves extraient une liste de toutes modifications ayant été effectuées localement et la renvoie au thread maître ; le thread maître intègre ces modifications et reprend son exécution. Afin de prouver la faisabilité de cette approche, la première version de CAPE a été implémentée en utilisant des points de reprise complets. Cependant, une analyse préliminaire a montré que la grande quantité de données transmises entre les threads et l’extraction de la liste des modifications depuis les points de reprise complets conduit à de faibles performances. De plus, cette version est limitée à des problèmes parallèles satisfaisant les conditions de Bernstein, autrement dit, il ne permet pas de prendre en compte les données partagées. L'objectif de cette thèse est de proposer de nouvelles approches pour améliorer les performances de CAPE et dépasser les restrictions sur les données partagées. Tout d'abord, nous avons développé DICKPT (Discontinuous Incremental ChecKPoinTing), une technique points de reprise incrémentaux qui supporte la possibilité de prendre des points de reprise discontinue lors de l'exécution d'un processus. Basé sur DICKPT, la vitesse d'exécution de la nouvelle version de CAPE a été considérablement augmenté. Par exemple, le temps de calculer une grande multiplication matrice-matrice sur un cluster des ordinateurs bureaux est devenu très similaire à la durée d'exécution d'un programme MPI optimisé. En outre, l'accélération associée à cette nouvelle version pour divers nombre de threads est assez linéaire pour différentes tailles du problème. Pour des données partagées, nous avons proposé UHLRC (Updated Home-based Lazy Relaxed Consistency), une version modifiée de la HLRC (Home-based Lazy Relaxed Consistency) modèle de mémoire, pour le rendre plus adapté aux caractéristiques de CAPE. Les prototypes et les algorithmes à mettre en œuvre la synchronisation des données et des directives et clauses de données partagées sont également précisées. Ces deux travaux garantit la possibilité pour CAPE de respecter des demandes de données partagées d'OpenMP
In order to explore further the capabilities of parallel computing architectures such as grids, clusters, multi-processors and more recently, clouds and multi-cores, an easy-to-use parallel language is an important challenging issue. From the programmer's point of view, OpenMP is very easy to use with its ability to support incremental parallelization, features for dynamically setting the number of threads and scheduling strategies. However, as initially designed for shared memory systems, OpenMP is usually limited on distributed memory systems to intra-nodes' computations. Many attempts have tried to port OpenMP on distributed systems. The most emerged approaches mainly focus on exploiting the capabilities of a special network architecture and therefore cannot provide an open solution. Others are based on an already available software solution such as DMS, MPI or Global Array and, as a consequence, they meet difficulties to become a fully-compliant and high-performance implementation of OpenMP. As yet another attempt to built an OpenMP compliant implementation for distributed memory systems, CAPE − which stands for Checkpointing Aide Parallel Execution − has been developed which with the following idea: when reaching a parallel section, the master thread is dumped and its image is sent to slaves; then, each slave executes a different thread; at the end of the parallel section, slave threads extract and return to the master thread the list of all modifications that has been locally performed; the master includes these modifications and resumes its execution. In order to prove the feasibility of this paradigm, the first version of CAPE was implemented using complete checkpoints. However, preliminary analysis showed that the large amount of data transferred between threads and the extraction of the list of modifications from complete checkpoints lead to weak performance. Furthermore, this version was restricted to parallel problems satisfying the Bernstein's conditions, i.e. it did not solve the requirements of shared data. This thesis aims at presenting the approaches we proposed to improve CAPE' performance and to overcome the restrictions on shared data. First, we developed DICKPT which stands for Discontinuous Incremental Checkpointing, an incremental checkpointing technique that supports the ability to save incremental checkpoints discontinuously during the execution of a process. Based on the DICKPT, the execution speed of the new version of CAPE was significantly increased. For example, the time to compute a large matrix-matrix product on a desktop cluster has become very similar to the execution time of the same optimized MPI program. Moreover, the speedup associated with this new version for various number of threads is quite linear for different problem sizes. In the side of shared data, we proposed UHLRC, which stands for Updated Home-based Lazy Release Consistency, a modified version of the Home-based Lazy Release Consistency (HLRC) memory model, to make it more appropriate to the characteristics of CAPE. Prototypes and algorithms to implement the synchronization and OpenMP data-sharing clauses and directives are also specified. These two works ensures the ability for CAPE to respect shared-data behavior

A water reticulation system is key infrastructure that enables hydraulic water services. It is therefore a critical component in providing the full level of water service to a city’s consumers. Extended water outages and below minimal pressure is a risk for the water network and especially for fire flows. GLS has developed and implemented a multi-threaded client-server software application based on the latest open-source EPANET 2.2 hydraulic analysis engine which now enables city-wide fire flow risk analyses on a property-by-property basis in reasonable time. Previously it has been virtually impossible to assess the risk on a city-wide basis, for each and every property, and to consider the improvement of such risk in the master plan (MP) of the water distribution system. Hence, the focus of the MP has been the provision of flows and pressures for the peak hour demand scenario in the network. Consequently, many township developments, densifications, and land use re-zonings require a separate and focussed specific fire risk analysis to ensure the existing system is capable of providing the requisite fire flow and pressure. If not, specific additional MP items related to the fire requirements of the specific property have to be investigated and considered for implementation. The fire flow risk analysis produces a GIS-based heat map displaying a Fire Risk Compliance Score (FRCS) of areas and properties where the current system is inadequate to deliver the fire flows and pressures. Such a heat map provides valuable information that can be used to improve and prioritise the MP and minimise future additional ad-hoc analyses for specific properties or developments. The fire flow risk analysis also allows the identification of pressure management zones where adjustments to the pressure regime are required in order to ensure requisite fire flows/pressures are achieved. Various methodologies based on Pressure Driven Analysis and Demand Driven Analysis have been evaluated and tested on models from South African cities. Great care has been take to optimise the multi-threaded communication of the application with the EPANET engine to streamline performance and support concurrent hydraulic analyses. In addition, a concept of automatically creating unique fire events to reduce the number of analyses, has been introduced for large models. This has resulted in smaller cities that can be analysed on modern PCs with few processor cores in a few minutes and large cities that can be analysed in reasonable time on high-core cloud-computing platforms. Visualisation in GIS-based software greatly helps to control the analyses and interpret results visually. Critical areas can be identified on a broader scale and allows for a rational approach to decide where to focus on network augmentation, or alternatively to provide on-site fire fighting capabilities.